Table 1 : Case Studies of Sudden Unexpected Infant Death in Breastfed Infants in an Unsafe Sleep Environment
Age of Infant |
Age of Mother |
Mother Obese ( Y / N ) |
Mother Under Influence Drugs / Alcohol ( Y / N ) |
Sleep Location |
Exclusively Breastfed ( Y / N ) |
Cosleeping ( Y / N ) |
Infant Found |
Manner of Death |
Case # 1 |
14 days 38 yrs Y N |
Futon Couch |
Y |
Y |
Mother ’ s breast over mouth and nose |
Accident due to anoxic encephalopathy and suffocation |
Case # 2 |
2 months 28 yrs Y Y Couch Y Y |
Mother on top of infant |
Accident due to asphyxiation and overlay |
Case # 3 |
14 days 24 yrs N N Adult bed Y Y |
Mother on top of infant |
SUID due to unsafe sleep environment |
Case # 4 |
2 months 21 yrs N N Adult bed N Y |
Infant face down in pregnancy pillow |
SUID due to unsafe sleep environment |
highest risk of death . 9 There are also significant cultural and racial disparities in the incidence of SUID . In Arkansas , African American families had higher rates of unsafe sleep and subsequent infant death compared to non-African American households . 3
Co-sleeping has been shown to increase rates of breastfeeding exclusivity and breastfeeding is a known protective factor for SUID ; however , breastfeeding on an unsafe sleep surface may increase the risk of SUID related deaths .
The cases presented in this report indicate a knowledge gap . Until we are able to determine which factors offer the most risk and protection and how to effectively educate families regarding these factors , the rate of SUID may continue to rise . Future studies should aim to determine these factors and determine how to effectively share information with families from various cultures and backgrounds in order to decrease infant mortality . Education is needed around safe places to breastfeed , alarms , or reminders to awaken mothers who might fall asleep while breastfeeding and messaging around the dangers of breastfeeding while on an unsafe sleep surface .
Conclusion
The relationship between breastfeeding , co-sleeping , or sleeping on an unsafe sleep surface and SUID is not well understood . Co-sleeping in an unsafe sleep environment may still be a significant factor in infant mortality and sudden unexpected infant death , even when the infant is breastfed .
References
1 . CDC . About SIDS and SUID . Accessed May 22,2020 . https :// www . cdc . gov / sids / about / index . htm ? CDC _ AA _ refVal = https :// www . cdc . gov / sids / AboutSUIDandSIDS . htm
2 . National Infant Mortality . United Health Foundation . America ’ s Health Rankings . Accessed May 26 , 2020 . https :// www . americashealthrankings . org / explore / health-ofwomen-and-children / measure / IMR
3 . Arkansas Infant and Child Death Review Program and Arkansas Children ’ s Hospital Injury Prevention Center : FY 19 Report on Deaths Occurring in 2017 .
4 . Moon RY and AAP Task Force on Sudden Infant Death Syndrome :
SIDS and Other Sleep-Related Infant Deaths : Evidence Base for 2016 Updated Recommendations for a Safe Infant Sleeping Environment . Pediatrics 2016 ; 138 ( 5 ): e20162940
5 . Erik Lambert A , Parks SE , Shapiro-Mendoza CK . National and State Trends in Sudden Unexpected Infant Death : 1990-2015 . Pediatrics 2018 ; Vol 35:19
6 . Moon RY and AAP Task Force on Sudden Infant Death Syndrome : SIDS and Other Sleep-Related Infant Deaths : Expansion of Recommendations for a Safe Infant Sleeping Environment . Pediatrics 2011 ; 128:1030-1039
7 . Colson ER , Willinger M , Rybin D , et al . Trends and factors associated with infant bed sharing , 1993-2010 : the National Infant Sleep Position Study . JAMA Pediatr 2013 ; 167:1032- 1037
8 . Ball , H . Bed-Sharing and Co-Sleeping : Research Overview . Accessed June 10,2020 . http :// evolutionaryparenting . com / bed-sharing-and-co-sleeping-research-overview /
9 . Bartick M , Smith LJ . Speaking out on safe sleep : evidence-based infant sleep recommendations . Breastfeed Med 2014 ; 9:417- 422
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